State psychiatric hospitals across the United States are experiencing strain due to a significant increase in patients referred through the criminal justice system. This shift has resulted in longer patient stays and reduced availability of beds for individuals seeking mental health treatment, contributing to capacity issues and extended wait times in facilities nationally and in states like Ohio.
Overview of Systemic Strain
State psychiatric hospitals nationwide are managing a rising number of admissions for patients referred by the criminal justice system. This trend is associated with extended patient stays and reduced bed availability for individuals seeking mental health treatment, posing operational challenges. These issues have been documented through interviews with patients, families, current and former hospital staff, advocates, legal professionals, and behavioral health experts.
Shifting Patient Demographics and Capacity Reduction
Nationally, psychiatric hospitals report staffing shortages, leading to patients being turned away or encountering long waits for treatment. A growing proportion of individuals admitted to these facilities are court-ordered following criminal charges.
In Ohio, the percentage of state hospital patients with criminal cases increased from approximately 50% in 2002 to about 90% at present. This rise in criminally involved patients has coincided with a 50% decrease in the total number of patients served by Ohio's state psychiatric hospitals over the past decade, from 6,809 to 3,421. Nationally, the total number of patients served decreased by approximately 17% during the same period, from 139,434 to 116,320. State-level responses have varied, including increased community services, bed expansion, and hospital closures.
The reduction in state facility capacity has occurred concurrently with the closure of psychiatric units in local hospitals, which often serve patients covered by Medicaid or who are uninsured. The financial stability of local hospital mental health services is anticipated to be further affected by federal legislation that reduced Medicaid funding over the next decade. Retired Ohio Supreme Court Justice Evelyn Lundberg Stratton, co-chair of the state attorney general's Task Force on Criminal Justice and Mental Illness, characterized the constricted flow of new patients as impacting individuals needing hospital beds outside the criminal justice system.
Wait Times and Patient Experiences
Ohio has approximately 1,100 beds across its six regional psychiatric hospitals. In May, the median wait time for a state bed was 37 days. Shanti Silver, a senior research adviser at the Treatment Advocacy Center, noted that this represents a significant period to await treatment in jail.
Extended wait times, often leading to individuals remaining in jails without mental health treatment, have resulted in lawsuits in states such as Kansas, Pennsylvania, and Washington. A 2014 class action case in Washington led to systemic changes, including expanded crisis intervention training and residential treatment beds.
Quincy Jackson III, a 28-year-old with psychosis, has experienced repeated interactions with homeless shelters, jails, clinics, emergency rooms, and Ohio's regional psychiatric hospitals. His mother, Tyeesha Ferguson, has described her son's experiences with the mental health system often leading to interaction with the criminal justice system. Between December 2023 and July 2025, Jackson was arrested or cited on at least 17 occasions, jailed at least five times, and treated over 10 times at various hospitals, including three state psychiatric facilities. A recent psychiatric evaluation notes his history of admissions to community and state facilities since 2015. Jackson waited 100 days in the Montgomery County jail for a state hospital bed during 2024.
Impact on Hospital Environment and Care Conditions
As the proportion of criminally charged patients in Ohio's hospitals has increased, reports from patients, former staff, and public records indicate impacts on patient care, including concerns about safety, increased restrictiveness, and understaffing. Katie Jenkins of NAMI Greater Cleveland noted that the shift toward criminally charged patients has altered the hospital environment.
In the first 10 months of 2024, at least nine patient escapes occurred from Ohio's regional psychiatric hospitals, compared to three in the preceding four years. Escapes involved instances such as patients lunging at staff or breaking windows. Following an incident where a patient absconded during an off-site dental trip, state officials implemented a policy prohibiting patients from leaving any of the six regional hospitals. This change impacted patients who previously had off-site privileges.
Federal records indicate safety concerns at larger state-run psychiatric hospitals in Ohio, including Summit and Northcoast. Federal investigations in 2019 and 2020 addressed patient deaths, including two suicides within six months at Northcoast. An employee reportedly told federal inspectors that understaffing was a persistent issue creating a "very dangerous" environment. Disability Rights Ohio filed a lawsuit in October against the department, alleging abuse and neglect related to a patient death, which was later settled. Retired sheriff's deputy Louella Reynolds, who worked at Northcoast, stated that the increase in criminally charged patients made hospitals "less safe," recalling a physical assault, and advocated for armed officers and increased staffing to manage patients.
State Responses and Ongoing Challenges
Ohio officials identified bed shortages as early as 2018. Subsequent actions included establishing task forces, expanding jail-based treatment, launching community programs and crisis units, and implementing a statewide emergency hotline. Despite these efforts, hospital backlogs have continued to increase.
Ohio officials have added 30 state psychiatric beds by replacing a hospital in Columbus and plan for a new 200-bed hospital in southwestern Ohio. However, Lisa Gordish, Ohio Director of Forensic Services, cautioned that adding capacity alone may not resolve the issue, citing experiences in other states where new beds quickly fill, and waitlists persist. LeeAnne Cornyn, former Director of the Ohio Department of Behavioral Health, stated in May that the agency "works diligently to ensure a therapeutic environment for our patients, while also protecting patient, staff, and public safety." Ohio Department of Behavioral Health officials declined interview requests for the articles, referring to a governor's working group report released in late 2024 for public responses.
Consequences of Inconsistent Treatment
Patrick Heltzel, a 32-year-old patient at Heartland Behavioral Healthcare, has resided there for over a decade after being found not guilty by reason of insanity for aggravated murder. Heltzel emphasized the necessity of long-term care for medication stabilization and developing "insight" into chronic conditions. Heltzel had previously been hospitalized for approximately 10 days in early 2013 after an incident with his father but was discharged despite his mother reportedly advocating for him to remain hospitalized and his reported feeling unwell. He subsequently stopped taking his medication. Within weeks, he killed Milton A. Grumbling III, believing Grumbling had abused him in another life, a delusion attributed to schizophrenia. Judges cited Heltzel's failure to adhere to medication before the killing as a reason for denying his request for conditional release. Katie Jenkins noted that psychiatric medications can take up to six weeks to become fully effective, suggesting patients may not achieve stabilization during typical hospital stays.
Quincy Jackson III reported that inconsistent care or unmedicated periods in jail "worsens my symptoms." After a 45-day stay at Summit — his longest at a state psychiatric hospital — Jackson returned to the Montgomery County jail in early September on misdemeanor charges related to an April altercation at a behavioral health hospital. His mother observed signs of distress during a jail video call and expressed concern about the lack of safe environments for her son to manage his symptoms in Ohio.
Broader Context
Mark Mihok, a municipal judge near Cleveland, noted an increase in individuals with serious mental illnesses in the criminal justice system. Several recent high-profile incidents involving individuals with reported mental health conditions have been cited by families, law enforcement, and mental health advocates as examples. These include:
- In August, a North Carolina man reportedly diagnosed with schizophrenia fatally stabbed a woman on a train.
- Also in August, a Texas gunman with a reported history of mental health issues killed three people at a Target store.
- In July, a Michigan man, whose family reported decades of needing treatment, attacked 11 people at a Walmart store with a knife.
- In June, police shot and killed a Florida man reportedly diagnosed with schizophrenia after authorities stated he attacked law enforcement.